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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT �7 4/_ T.............-...........f.r................... Permit No. U (Complete in Triplicate) .........."..............................I............... Date Issued .1..x-.7".7` .................................................... I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION`.: .................. ....... ..........................CENSU5 TRACT ' Owner's Name ..:. ..T.ca.i:.z.::w.Y_.......: .......... .........._ .- ....._.. ...Phone Address - .U-- �'.- - 1: .... ......... .:. . City....... ........... ........................... ..._.._.._..... ....License # --� s l Phone Contractor's Name ... .. :..C_ ..i?r.,.�-r S ----------------------- Installation will serve: Residence ®.Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Otherl }} y Number f living/nits:......t..... Number of bedrooms :.....J_...Garbage Grinder ....._...... Lot Size.'._ ./__..�............................... A L. ` , r va Water Supply: Public System and name ....--------• C,i..l... .... - ..................................... ........:..................P i to ❑ Character of soil to aidepth of 3 feet: Sand 0 .Silt[3 -Clay E] Peat EE Sandy Loam 0 Clay Loam 0 Hardpan❑ Adobe:($q Fill Material ......:1.... If yes,type ............................ \\1 (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,j ......::_..�'.%�_�_ Liquid Depth ....:�.�.�......... f PACKAGE TREATMENT J ) SEPTIC TANK�jQ �'S€ze... � �� ,• t I Capacity n �?.U.--:: Type _-:- `..c��... Material.��.-ate No.`-Compartments ... t, ............... _Jr Distance to nearest: Well .._ .... . ..............Foundation:......., .......... Prop. Line .....1;�...... ...--•-- iI t6() ........ _ len th of each line._._....i.�..�,. .'' Total Len th .........s:�j �...... LEACHING LINT: No. of tines �............. g .._. g j 'D' Box .1'/..... Type Filter Material ......:. ..`...`_.Depth Filter Material ............................`' I Distance to nearest: Well .................... ... Foundation Property .......... SEEPAGE`PIT Depth _..4 _. . !_._Diameters .... ��NumlOer_...... ...... ........ Rock Find „Yes a No r Water Table Depth ................Y.&..._..... .............Rock Size ........�v1C?.............. � Distance to nearest: Well .......I..... .� —. _•. .............Foundation ... . ...... Prop. Lino ... ... ........... .." Permit # ..............•------------ ..__,.REPAIR/ADDITION(Prov. Sanitation Date .................................. t Septie.,Tank (Specify Requirements) ............. ...........................................................-...... .....` - Disposal Field (Specify Requirements) .................. -_-••- -_-•- _- •-• ..•-V��-- -•-•---- ....................................................... ......•-••.- ....._...------------- X..... �.._... ......................................_\....................... : t i .................................................................................................................. .............................-...................................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will J'be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ry, "1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of Californla:'� . 1; Signed ............................. .................... Owner A By _._ a . ...................... .............. . (If other than owner) t r t FOR DEPARTME14T USE ONLY j t APPLICATION ACCEPTED BY _- . .... ................. . ......• DATE.................... ....".? .. BUILDING.-PERM-IT-ISSUED :::........: :.::.::.:....DATE ...................................... li ADDITIONAL COMMENTS ........ ........................................-............_....._ -------•----.... .: .....-----.......__----•-_... ...........---•------ ................................................ ............................�.................................. . ...............I.......................-- .-............................. i .................. ........... ... .. :..:..............:...........:............... .........: �/�. ,. ............ Final Inspection by: tel- ..... ......................................................Date ............. � .....�. ............... F SAN JOAQU#N -LOCAL' HEALTH DISTRICT .` r. .N 1.3 24 1.1e9 2o..- 5M 7/72 3 X